Tonsillectome



March 2, 1948. O c DANlELS, 5 2,436,989

IONS ILLECTOME Filed May 29, 1947 2 Sheets-Sheet 2 11 Q I @OW ZNVENTOR./Sn

Patented Mar. 2, 1948 UN! TED STATES PATENT '0 PRICE TONSILLECTOME Oscar'C. Daniels, -Sr., Oriental, NJC.

Application May 29, 1947, Serial'No. 751,252

6 Claims. (015128-309) 1 My :present invention has for its obj ecttoprovide 'a surgical instrument adapted particularly for the use'ofmembers of the medical profession :inthe removal of tonsils comprisingan arrangementof parts capable of insertion into a patients oral-cavityfor=engagement with and separation of "the tonsil from the surroundingtissue -of the throat and applying a .hemostat thereto and while thetissues are so held to sever the enucleated 'tonsil therefrom, at thesame time "lessening the possibilityof hemorrhage.

My invention has for its further object to provide in:'an instrument ofthe character described certain novel arrangements-in the construction.of the zpillory and its hemostatic blade together with the cuttingblade and the respective =operating members of said blades, the firstbeing arranged for a quick forceful operation, the other a comparativelyslower succeeding movement, said operating members being slidablymounted on-a suitable handle and readily removable therefrom to permitsterilization-of the instrument.

To these and other ends my invention comprises further improvements andadvantages as will be further described in the accompanyingspecification, the novel features thereof being set forth in theappended claims.

In the drawings: 7 g I Figure -1 is a view showing in side elevation asurgicalinstrument embodying my invention.

:Fig. -1.

Figure is a longitudinal cross sectional view, similar to Fig. '3 butshowing the barrel of the instrumentstripped of the movable parts.

Figure Bis a bottom plan view of the forward or distal end of theinstrument frame, shown in Fig. 5.

Figure '7 is an enlarged cross taken on theline "I -'1 of Fig. 2.

Figure 8 is aplan view of the cuttingblade.

Figure '9 is a side of the operating .rod for the cutting blade.

Figure .10 is a cross sectional view taken on the hue l 0l0 of Fig. 2showing the transversely movable pivoted locking member on the barrelsectional View for retaining the sliding parts thereon in operativeposition, and

Figure ll is-a detail sectional view taken on'the line ll-il of Fig/l0showing the manner of journalling the locking member and providing asnap latch for holding it in the closed position.

Similar reference numerals, in the several 'figures, indicatesimilarparts.

For the purpose of performing 'tonsillotom-y operations with the minimumdamage and subsequent physical inconvenience to the patient, at the-sametime lesseningthe danger ofhemorr'hage atthe point-of severage of thetonsillhaveprm vided an instrument capable of being used in either theright or left hand of the surgeon having a irame adaptedto be insertedin an oral cavity and-provided at its extremity with a window in which atonsil may be pilloried and subsequently guillotine'd by independentlyadjustable longitudinal members capable of being manipu- -lated at therear end of the frame.

In carryingout my invention I provide ,a frame carried atits rear end onahandle -l disposed'at a slight angle thereto. The-frame is of asuitable length so that when inserted in a vpatient/s oral cavity itsinnner end will conveniently reach the sides of the throat while itsouter end is free of the patients lips. At its rear or outer end theframe hasa cylindricalportion 2 from the center .of the lowerforward-edge of which is a smaller cylindrical extension 3 carrying atits extremity a head l. The latter is substantially the equal in widthto the diameter of the cylinder 2 and extends laterally across the upperportion of the extension 3 and projects beyond it, the extension on itslower side being beveled, as indicated at 5 to :provide clearance. onits upper side the head has a'iiatfacet which lies slightly'below the:plane, of the upper-edge of the extension 3 and along'its itWO dg6S areguide rails -l which merge into the semi-circular forward -or dista1 endof the-instrument, as indicated at8. 'On their proxi- .it is "throughthis window or fen'estra that the surgeon manipulates the tonsil tocause it "to 'be enucleated with reference to the tissue in which it isembedded.

In the upper side of the parts 2 and 3 of the frame I provide alongitudinal slot having parallel side walls and a semi-circular bottom.This slot in the part 3; as indicated at IT, (Fig. 5) is about half thedepth thereof, but within the part 2 it is deepened, as indicated at l8,and where it extends into the head 8 it is also depressed and ofsubstantially one-half the width in the portion lying below the face 6,as indicated at Hi. In the cylinder 2 extending inwardly from its rearend, in a plane above the top of the extension 3, there are formedarcuate cutouts 29 the inner ends of which form shoulders 2|. For adistance in- Wardly from the rear end of the cylinder 2 the top of theslot therein is widened slightly as indicated at 22 forming shoulders23, (Fig. 2). At this point the frame is slotted transversely, asindicated at 24, to accommodate the locking element shown in Figs. 10and ll and located in a position forward of said slot, the cylinder iscut away on its right hand side to provide a recess 25, the rear edge ofwhich is curved to form a cam surface 28.

Mounted on the above described frame and lying in the longitudinalrecesses therein are the operating members for projecting and retractingthe two tools which are operated successively. The element or tool whichis used to first apply a hemostat to the tissues also serves inconjunction with the fenestra I6 of the frame to enucleate a faucialtonsil. It comprises a slide in the form of a flat plate 21 lying withinthe rails 1 on the head 4 having a rounded end fitting the inner curvededge of rim 8 of the head. This fiat plate 21 is provided with a centralelongated opening 28 and is supported on a rod 29 which lies in thegroove of the part 3 of the frame and has at its rear end an upwardlyextending rectangular boss 39 which lies in the forward end of the slotin the cylindrical enlargement 2 of the frame and serves to resist anytwisting movement of the plate 21.

In operating the instrument the rod 29 is manipulated from a point inrear of the frame its first movement for the greater portion of itstravel to engage the tissues in the operating area being effected byhand or thumb pressure and its final movement to compress said tissuesbeing completed by a rotary movement of the maniplating element. Theseresults are accomplished by journaling on the outer end of the boss 2.cylindrical extension 3| rotatable on an axis lying above the plane ofthe rod 29 formed by a journal pin 32 which is locked in the boss 39 bya pin 33 extending across an annular recess in the pin. The cylindricalmember 3| fits in the arcuate recess 29 of the frame piece 2 and istherefore normally prevented from displacement on the frame. At theinner end of the member 3| is a stud 34 which defines the upper side ofsaid member in that the stud is freely movable lengthwise of the rearend of the longitudinal slot of the frame and is positioned to cooperatewith the cam surface when the pressure plate has partly closed thefenestra l6.

Manipulation of the hemostat element just described is effected by thebutterfly wings 35 secured in a crosswise slot at the extremity of, the

rotatable extension 3|. The latter is reduced in cross section providingthe part 3| with an inner shoulder 36. Strengthening of the union ofsaid parts is accomplished by threading on said extremity a nut 31 whichis likewise slotted and securing it together with said wings by a locknut 4 38. In the area between the nut 31 and the shoulder 36 is a screwthread 39 carrying the nut 40 which operates the guillotine and to thisend is provided with studs 4| on its rim and on its forwardly extendinghub is provided with an annular recess forming a circular flange 42.

The guillotine is the knife blade l5 (Fig. 8) carried in a transverseslot in the plate 21. It is slightly wider than the plate 21 so that itsedges 43 fit in the guide channels 9 of the head 4. Thus the blade isguided and the plate 21 prevented from being dislodged from the head 4of the frame. The forward sharpenededge 44 of the knife is curved andwhen moved forwardly it enters the transverse slot ill in the head. Atits rear side the blade has a tongue t5 provided with a transverse slot45 which lies in the area of the opening 28 of plate 27.

Extending lengthwise of the frame and riding in the slotted portions I9,I! and I8 thereof is a guillotine push 'rod 47 and since this underliesthe rod 29 I also provide said rod on its lower side with a groove inorder to make the parts of the instrument as compact as possible. Theforward end of the guillotine push rod is bent downwardly slightly asindicated at 49 (Fig. 9) to pass beneath the tongue 45 of blade I5 andits extremity 59 projects upwardly through the blade slot 49. Aninterlock is provided for these parts by forming the extremity Ell,above the blade, with ears '5| which lie in the plane of the axis of therod 47 and are preferably created by upsetting the metal from oppositesides. The blade slot is purposely narrower than the diameter of the rodextremity 59 but is provided at its center with an enlargement 52 so bythis arrangement it will be seen that the blade and rod may bedisconnected by a relative right angular adjustment of the parts whenthey are removed from the frame.

At the outer end of rod 41 is a cylindrical enlargement 53 (Fig. 9)having a groove 54 embracing .the flange 42 on nut 43. The length of theguillotine rod is such that when the nut 49 is backed off on screw 39into engagement with the inner face of nut 31 the inner end of the rodwill hold the cutting edge 44 of the blade I5 retracted behind thecurved end of the late 21. Likewise the plate is advanced so as to applya hemostatic action on tissues said knife having been moved bodilyforward with the plate may be subsequently advanced further to sever thetissues by turning up the nut 49 on its screw.

In an instrument of this character it is desirable to fit the partssomewhat loosely to facilitate their being disassembled forsterilization and subsequent assembly by a nurse or doctor's assistant.This, however, introduces a disadvantage because the surgeon usuallyoperates upon a patient who is lying in a prone position and as he holdsthe instrument by the handle he introduces the frame into the oralcavity in a vertical position. Hence this looseness of the parts willpermit the parts thereon to gravitate and close the fenestra Hi. It isessential to prevent such accidental occurrences and I have found inpractice that there are two ways to avoid thi interruption to a surgeonstechnique. One of these is to bend or distort the rod 4? sufiiciently tocreate a slight friction against the walls of the groove in the frame,and the other, which I deem preferable, is to provide a leaf spring 55on the lower side of the part 53, which frictionally engages the bottomit of the frame groove. This spring is pinned at its outer end, to thepart 53 and also serves an additional function of holding of theoperating elements, yet may be released when the parts are to bedisassembled. The

shoulders -23 onthe cylindrical part2 of the frame define one side of atransverse slot 56 in which lies a curved finger 51 normally extendingacross the top of slot in the frame and lying in the path of the stud34. This memberis so positioned on the frame that the engagement of thestud therewith serves to position the hemostat platefZ'i and the'knifethereon in rear of the fenestral opening ['6 at the inner end of theframe. The finger -51 ispivoted on a'journal pin'58 inserted in a borehole which extends inwardly from the rear end of'part 2 of the frame. Ina second parallel bore hole I provide a spring pressed latching stud 59(Fig. 11) which cooperates with a countersunk depression 60 (Fig. 10) torestrain'the "finger against accidental movement into a releasedposition-as shown in dotted lines in Fig. 10.

The nicety and practicability of this instrument will best beappreciated from a brief description of its use in performing atonsillectomy. With the patient lying on his back the frame 3 4 isinsertedin the mouth with the plate 21, or'hemo static blade, facing thetonsil that is to be removed. The distal end 8 is inserted between thetonsil and the posterior pillar and taking in the lower pole or base ofthe tonsil. The shaft or frame may extend diagonally across the oralcavity and even be pressed against the opposite side thereof thusproviding an unobstructed View of its inner end. In this position theinstrument may be manipulated slowly to dip or lift the tonsil out ofits bed in the sinus tonsilaris and cause it to pass into the fenestrait of the instrument which may be aided by a manual pressure against thetonsil to fully press it through the fenestra. At this stage pressure ofthe thumb, on the hand holding the handle I, against the end of nut 38will advance the plate 21 sufiiciently to break the tonsil from its bed,care being taken to release any tissue that may be caught, after whichthe plate 21 is advanced by turning the wing nut 35. The force requiredat this stage of the operation is accomplished by the stud 34 ridingacross the cam surface 26 and applies the hemostat to the tissues beforethey are severed. At the same time enucleation of the tonsil occurs.turning nut 41! advancement of rod 41 pushes the knife forward in theplate 21 into the slot ID in.

the extremity or bow 8 of the frame. The instrument is released fromtissue held by the hemostat by reversing the direction of movement ofthe wing nut 35.

To disassemble the instrument it is merely necessary to swing the curvedfinger 54 into the dotted line position shown in Fig. 10 when all of themovable parts may be retracted into release position on the frame. Bythis movement the inner end of the cylindrical extension 3! passesbeyond the shoulders 23 and is free of the arcuate recesses 2i! so thatthe plate 27 and knife are disengaged from their guides. The rods 29 and41 being then released at both ends may be lifted clear of the slot inthe frame pieces 2 and 3.

I claim:

1. In a hemostatic tonsillectome, the combination with a frame forinsertion in the oral cavity comprising a shaft carrying at its outerend an enlargement and at its inner end a flat transverse head providedwith an aperture, said frame being Thereupon by 6 slotted"longitudinally on its upper side, a marginal rail surrounding the endof the head and extending at the sides thereof and provided withundercut guide 'ways,-of a push rod lying in-said frame slot having ahemostat'plate located between the rail sides "Whichis provided with aslot "extending rearwardly from its'forward end in the plane of the railguide ways, an operating rod underlyingthepush rod in the frame slot -aknife bladelyingintheslot ofsaid-plate with its edges engaging the railguide ways and attached to the operating rod, and means'at the outer endof the frame for advancing and retracting said rod on the frame.

2. Ina hemostatic tonsillectome, the combination'with a frame forinsertion in the oral cavity comprising a shaft carrying at its'out'er'end an enlargement and at its inner end a flat transverse headprovided with an aperture, said frame being slotted longitudinally onits upper side, a

marginal rail surrounding the end of the head and extendingat the sidesthereof and provided with'undercut-guide ways, of a push rod lying in'said frame slot having, ahemostat plate located between the rail sides,said plate being provided with an aperture and also slottedtransversely, an apertured knife blade lying in the plate 5101', havinglateral edges engaging in the rail guide ways, an operating rod locatedin the frame slot beneath the push rod and having its' forwardendextending below the knife blade and upwardly into engagement With theaperture therein, and means at the rear end of the frame for advancingand retracting saidrods thereon.

3. In a hemostatic tonsillectome, the combination with a frame forinsertion in the oral cavity comprising a shaft carrying at its outerend an enlargement and at its inner end a flat transverse head providedwith an aperture, said frame being slotted longiudinally from the rearside of the head aperture to the rear side of its enlargement, amarginal rail surrounding the end of the head and extending at the sidesthereof and provided with undercut guide ways, of a cylindrical push rodlying in the frame slot having at its forward extremity a hemostat platelocated between the rail sides, said plate being provided with anaperture and also slotted transversely and said push rod being providedon its lower side with a guide slot, a knife blade located in the plateslot with its lateral edges resting in the rail guide ways and providedwith an elongated aperture, an operating rod located beneath the pushrod in the longitudinal frame and rod slots, a forward end on saidoperating rod extending upwardly through the blade slot and having aprojection extending over said blade, and means at the rear end of theframe for advancing and retracting said rods thereon.

4. In a hemostatic tonsillectome, the combination with a frame forinsertion in the oral cavity comprising a shaft carrying at its outerend an enlarged portion and at its inner end a pillory head andguillotine, said frame enlargement being slotted lengthwise on its upperside and having cutaway portions in the walls of said slot, a push rodlying in the frame slot having a hemostat plate at its forward endcooperating with the head, and at its outer end a cylindrical stem, thesides of which extend into said cut outs, of a knife blade on saidplate, a rod for operating it underlying the push rod, a spring thereonengaging the bottom of the frame slot and providing frictionalresistance to the movement of both rods, and means at the rear end ofthe frame for advancing and retracting both rods thereon.

5. In a hemostatic tonsillectome, the combination with a frame forinsertion in the oral cavity comprising a shaft carrying at its outerend an enlarged portion and at its inner end a pillory head andguillotine, said frame enlargement being slotted lengthwise on its upperside and having cut out portions at the sides of the slot, saidenlargement being also slotted at oneside at a point forward of said cutouts and provided with a transverse slot substantially midway of the cutouts, push rods superimposed in the frame slot, the upper rod carryingat its forward end a hemostat plate cooperating with the frame head, andhaving at its rear end a cylindrical stem lying in the cutouts, a studthereon projecting above the upper edge of the frame enlargement, acurved finger pivoted at one side of the latter in the transverse slottherein and extending into the path of said stud, a guillotine knifecarried on the hemostat plate and connected to the other push rod, andmeans at the rear end of the frame for advancing and retracting bothrods.

6. In a hemostatic tonsillectome, the combination with a frame forinsertion in the oral cavity comprising a shaft carrying at its outerend an enlarged cylindrical portion and at its inner end a pillory headand guillotine, an anguarly disposed handle on'the under side of thecylinder, the latter being provided on its upper side with alongiutdinal slot the side walls of which are undercut, said cylinderhaving at the forward end of the undercuts a lateral slot and alsoprovided on its side in alinement with the handle a transverse slot,push rods superimposed in the frame slot the upper rod carrying at itsforward end a hemostat plate cooperating with the frame head, aguillotine knife on said plate connected to the other rod, a cylindricalstem journaled on the outer end of the upper rod and lying in saidcutouts, a studon the upper side of the cylinder projecting above thetop of the cylinder, a curved finger pivoted at one side of the latterand normally lying in the transverse slot thereon in the path ofretractive movement of said stud and capable of being tripped intoinoperative position by the thumb of the operator's hand grasping thehandle, a spring on the lower push rod engaging the bottom of the slotin the cylinder normally providing resistance to lengthwise movement ofsaid rods relatively to the frame and also serving to elevate themthereon when the cylindrical stem is retracted out of engagement withsaid cutouts, and means at the rear end of the frame for advancing andretracting said rods.

OSCAR C. DANIELS, SR.

